Column: The abortion battle ahead – and a way out of it

In the presidential campaign, no issue separated Donald Trump and Hillary Clinton more starkly than abortion. He promised to ban it after the 20-week mark of a pregnancy and appoint Supreme Court justices who would overturn Roe v. Wade. She vowed to protect “the right to safe and legal abortions” against all challenges.

With Republicans in control of Congress and most state governments, expect numerous battles on this front. Ohio Gov. John Kasich, a relative moderate in the GOP presidential primaries, just signed a bill largely banning the procedure after the 20th week of a pregnancy, with no exception for cases of rape or incest. Seventeen other states have similar laws, two of which have been struck down by federal courts.

But pro-life people shouldn’t get their hopes too high. Trump would need at least one more Supreme Court vacancy (besides the one left by Antonin Scalia’s death) to have any hope of reversing Roe — and his arrival in the White House will provide reason enough for every liberal justice to stay. Nor would the demise of Roe mean a nationwide ban on abortion. It would only allow states to make their own decisions.

In that event, it would most likely remain legal in some 20 states, including California, New York, Illinois, Florida and Washington. Women in states with abortion bans could travel to those places — or Canada — to end their pregnancies. Activist groups would help poor women do so.

Medicines that induce abortion would surely be available on the black market, as recreational drugs are. As in the days before Roe, some women would seek out medical professionals providing illegal abortions or even try to self-induce, despite the risks.

If the goal is to reduce the number of abortions, legal restrictions are of minimal value. By raising the cost and effort required for women to end their pregnancies, such laws would prevent some from doing so. But the reduction would most likely be small. Making much difference in abortion rates requires a different approach.

Abortion is an intractable issue because it involves an irreconcilable conflict between two supreme values: protection of life on one side and personal freedom and physical autonomy on the other. But it’s not impossible to uphold both. Hillary Clinton was onto something when she said in 2008 that abortion should be “safe, legal and rare — and by ‘rare,’ I mean rare.”

What is needed is a recognition by pro-choice people that there is something awful about destroying a fetus and a recognition by pro-life people that there is something terrible about depriving a woman of control of her body. Such understanding might impel the two sides to look for ways to prevent both horrors.

Katie Watson, a professor at Northwestern University’s Feinberg School of Medicine, notes that “45 percent of pregnancies in the United States are unplanned — and 42 percent of unplanned pregnancies are terminated with abortions.” One obvious way to bring down the abortion rate is to give women ready access to contraception.

This, alas, is where the Republican Party’s concern for life collides with its contempt for Obamacare. The Affordable Care Act mandates that health insurance providers, including Medicaid, offer 18 different types of birth control, from the pill to sterilization, at no cost to the patient. Repealing that rule would almost certainly mean more pregnancies terminated.

We know contraception can curb abortion. Between 2008 and 2011, reports the Guttmacher Institute, the unintended pregnancy rate dropped by 12 percent — and the abortion rate fell by 13 percent. Behind the declines was the growing use of long-acting contraceptives (IUDs and implants), which are exceptionally reliable. How reliable? “Comparable to tubal ligation,” says Watson.

Republican politicians want not only to scrap Obamacare but also to cut off funds to Planned Parenthood — which provides birth control to some 3.5 million people each year. It’s understandable that pro-life advocates don’t want tax money used for abortions. But that’s already forbidden.

The money from Washington pays for reproductive services and other health care, most of it to Medicaid recipients. The money it gets for these services, contrary to myth, doesn’t subsidize abortions — any more than the money you spend on bread at the grocery subsidizes its wine sales. What it does is expand use of birth control.

Facilitating access to contraception promises to sharply curtail the loss of fetal life without forcing unwilling women into childbirth. Politicians can make abortion illegal. The better goal is to make it unnecessary.